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Koster LA, Kaptein BL, van der Linden-van der Zwaag EHMJ, Nelissen RGHH. Knee kinematics are not different between asymmetrical and symmetrical tibial baseplates in total knee arthroplasty: A fluoroscopic analysis of step-up and lunge motions. Knee Surg Sports Traumatol Arthrosc 2024; 32:1253-1263. [PMID: 38488225 DOI: 10.1002/ksa.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE This clinical fluoroscopy study investigated knee kinematics of two different cemented fixed-bearing, posterior-stabilised (PS) total knee arthroplasty (TKA) designs: an asymmetric tibial component including an asymmetric insert designed to optimise personalised balance and fit and its precursor symmetrical design with symmetric insert. METHODS A consecutive series of patients (16 TKAs from each treatment group) participating in a randomised controlled trial comparing TKA migration was included. The exclusion criterion was the use of walking aids. Flat-panel fluoroscopic recordings of step-up and lunge motions were acquired 1-year postoperatively. Medial and lateral contact points (CPs) were determined to calculate CP displacement, femoral axial rotation and pivot position. Using linear mixed-effects modelling techniques, kinematics between TKA designs were compared. RESULTS During knee extension between 20° flexion and full extension, the CPs moved anteriorly combined with a small internal femoral rotation (a screw-home mechanism). Whereas CP movement was reversed: femoral rollback, external femoral rotation while flexing the knee between full extension and 20° knee flexion, At larger flexion angles, femoral axial rotation (FAR) occurred around a lateral pivot point both during step-up and lunge. The symmetric design had a 2.3° larger range of FAR compared to the asymmetric design during lunge (p = 0.02). All other kinematics were comparable. CONCLUSION Despite the differences in design, this study showed that the asymmetric and symmetric PS TKA designs had mostly comparable knee kinematics during step-up and lunge motions. It is therefore expected that the functionality of the successor TKA design is similar to that of its precursor design. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Lennard A Koster
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rob G H H Nelissen
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
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Broekhuis D, Meurs WMH, Kaptein BL, Karunaratne S, Carey Smith RL, Sommerville S, Boyle R, Nelissen RGHH. High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery. Bone Jt Open 2024; 5:260-268. [PMID: 38555947 PMCID: PMC10981996 DOI: 10.1302/2633-1462.54.bjo-2023-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Aims Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.
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Affiliation(s)
- Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemijne M. H. Meurs
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L. Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Scott Sommerville
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rob G. H. H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Van der Lelij TJN, Koster LA, Marang-van de Mheen PJ, Toksvig-Larsen S, Nelissen RGHH, Kaptein BL. Influence of marker-selection method in radiostereometric analysis of total knee arthroplasty on tibial baseplate migration patterns: a secondary analysis of a randomized controlled trial with 5-year follow-up. Acta Orthop 2024; 95:157-165. [PMID: 38597226 PMCID: PMC10959012 DOI: 10.2340/17453674.2024.40184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Different marker-selection methods are applied to represent implant and tibial segments in radiostereometric analysis (RSA) studies of total knee arthroplasty (TKA). Either a consistent set of markers throughout subsequent RSA examinations ("consistent-marker method") is used or all available markers at each follow-up ("all-marker method"). The aim of this secondary analysis was to compare marker-selection methods on individual and group level TKA migration results. METHODS Data from a randomized RSA study with 72 patients was included. Tibial baseplate migration was evaluated at 3 months, 1, 2, and 5 years postoperatively with both marker-selection methods. Additionally, migration was calculated using 5 fictive points, either plotted based on the consistent set of markers or all available markers. RESULTS Migration could be calculated with both marker-selection methods for 248 examinations. The same prosthesis and bone markers (n = 136), different prosthesis markers (n = 71), different bone markers (n = 21), or different prosthesis and bone markers (n = 20) were used. The mean difference in maximum total point motion (MTPM) between all examinations was 0.02 mm, 95% confidence interval -0.26 to 0.31 mm. 5 implants were classified as continuously migrating with the consistent-marker method versus 6 implants (same 5 plus one additional implant) with the all-marker method. Using fictive points, fewer implants were classified as continuously migrating in both marker-selection methods. Differences between TKA groups in mean MTPM were comparable with both marker-selection methods, also when fictive points were used. CONCLUSION Estimated group differences in mean MTPM were similar between marker-selection methods, but individual migration results differed. The latter has implications when classifying implants for estimated risk of future loosening.
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Affiliation(s)
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, Delft, The Netherlands
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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van der Lelij TJN, Marang-van de Mheen PJ, Kaptein BL, Koster LA, Ljung P, Nelissen RGHH, Toksvig-Larsen S. Migration and clinical outcomes of a novel cementless hydroxyapatite-coated titanium acetabular shell: two-year follow-up of a randomized controlled trial using radiostereometric analysis. Bone Joint J 2024; 106-B:136-143. [PMID: 38295835 DOI: 10.1302/0301-620x.106b2.bjj-2023-0862.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Aims The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface. Methods Overall, 87 patients undergoing total hip arthroplasty (THA) were randomized to either a Trident II HA or Trident HA shell, each cementless with clusterholes and HA-coating. All components were used in combination with a cemented Exeter V40 femoral stem. Implant migration was measured using radiostereometric analysis (RSA), with radiographs taken within two days of surgery (baseline), and at three, 12, and 24 months postoperatively. Proximal acetabular component migration was the primary outcome measure. Clinical scores and patient-reported outcome measures (PROMs) were collected at each follow-up. Results Mean proximal migrations at three, 12, and 24 months were 0.08 mm (95% confidence interval (CI) 0.03 to 0.14), 0.11 mm (95% CI 0.06 to 0.16), and 0.14 mm (95% CI 0.09 to 0.20), respectively, in the Trident II HA group, versus 0.11 mm (95% CI 0.06 to 0.16), 0.12 mm (95% CI 0.07 to 0.17), and 0.14 mm (95% CI 0.09 to 0.19) in the Trident HA group (p = 0.875). No significant differences in translations or rotations between the two designs were found in any other direction. Clinical scores and PROMs were comparable between groups, except for an initially greater postoperative improvement in Hip disability and Osteoarthritis Outcome Symptoms score in the Trident HA group (p = 0.033). Conclusion The Trident II clusterhole HA shell has comparable migration with its predecessor, the Trident hemispherical HA cluster shell, suggesting a similar risk of long-term aseptic loosening.
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Affiliation(s)
| | - Perla J Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
- Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, Delft, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Ljung
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Hasan S, van Schie P, Kaptein BL, Schoones JW, Marang-van de Mheen PJ, Nelissen RGHH. Biomarkers to discriminate between aseptic loosened and stable total hip or knee arthroplasties: a systematic review. EFORT Open Rev 2024; 9:25-39. [PMID: 38193539 PMCID: PMC10823569 DOI: 10.1530/eor-22-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Background Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross loosening. A multitude of biomarkers may discriminate between loosened and stable implants, but it is unknown which have the best performance. The present systematic review aimed to assess which biomarkers have shown the most promising results in discriminating between stable and aseptic loosened THAs and TKAs. Methods PubMed, Embase, Web of Science, Cochrane Library, and Academic Search Premier were systematically searched up to January 2020 for studies including THA/TKA and biomarkers to assess loosening. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the ICROMS tool to classify the quality of the studies. Results Twenty-eight (three high-quality) studies were included, reporting on a median of 48 patients (interquartile range 28-69). Serum and urine markers were evaluated in 22 and 10 studies, respectively. Tumor necrosis factor α and osteocalcin were significantly higher in loosened compared with stable implants. Urinary N-terminal telopeptide had significantly elevated levels in loosened prostheses. Conclusion Several serum and urine markers were promising in discriminating between loosened and stable implants. We recommend future studies to evaluate these biomarkers in a longitudinal fashion to assess whether progression of loosening is associated with a change in these biomarkers. In particular, high-quality studies assessing the usability of these biomarkers are needed.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter van Schie
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Safety & Security Science, Delft University of Technology, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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van der Lelij TJ, Marang-van de Mheen PJ, Kaptein BL, Toksvig-Larsen S, Nelissen RG. Continued Stabilization of a Cementless 3D-Printed Total Knee Arthroplasty: Five-Year Results of a Randomized Controlled Trial Using Radiostereometric Analysis. J Bone Joint Surg Am 2023; 105:1686-1694. [PMID: 37651549 PMCID: PMC10609712 DOI: 10.2106/jbjs.23.00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Three-dimensional (3D) printing of highly porous orthopaedic implants aims to promote better osseointegration, thus preventing aseptic loosening. However, short-term radiostereometric analysis (RSA) after total knee arthroplasty (TKA) has shown higher initial migration of cementless 3D-printed tibial components compared with their cemented counterparts. Therefore, critical evaluation of longer-term tibial component migration is needed. We investigated migration of a cementless 3D-printed and a cemented tibial component with otherwise similar TKA design during 5 years of follow-up, particularly the progression in migration beyond 2 years postoperatively. METHODS Seventy-two patients were randomized to a cementless 3D-printed Triathlon Tritanium (Stryker) cruciate-retaining (CR) TKA or a cemented Triathlon CR (Stryker) TKA implant. Implant migration was evaluated with RSA at baseline and postoperatively at 3 months and at 1, 2, and 5 years. The maximum total point motion (MTPM) of the tibial component was compared between the groups at 5 years, and progression in migration was assessed between 2 and 5 years. Individual implants were classified as continuously migrating if the MTPM was ≥0.1 mm/year beyond 2 years postoperatively. Clinical scores were evaluated, and a linear mixed-effects model was used to analyze repeated measurements. RESULTS At 5 years, the mean MTPM was 0.66 mm (95% confidence interval [CI], 0.56 to 0.78 mm) for the cementless group and 0.53 mm (95% CI, 0.43 to 0.64 mm) for the cemented group (p = 0.09). Between 2 and 5 years, there was no progression in mean MTPM for the cementless group (0.02 mm; 95% CI, -0.06 to 0.10 mm) versus 0.07 mm (95% CI, 0.00 to 0.14) for the cemented group. One implant was continuously migrating in the cementless group, and 4 were continuously migrating in the cemented group. The clinical scores were comparable between the groups across the entire time of follow-up. CONCLUSIONS No significant difference in mean migration was found at 5 years between the cementless and cemented TKA implants. Progression of tibial component migration was present beyond 2 years for the cemented implant, whereas the cementless implant remained stable after initial early migration. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Perla J. Marang-van de Mheen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart L. Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Yüksel Y, Koster LA, Kaptein BL, Nelissen RGHH, den Hollander P. No difference in component migration at five years between the cemented cruciate-retaining ATTUNE and PFC-Sigma knee prosthesis: an update of a randomized clinical radiostereometry trial. Bone Joint J 2023; 105-B:1168-1176. [PMID: 37907075 DOI: 10.1302/0301-620x.105b11.bjj-2022-0839.r4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes. Methods A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months' follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively. Results At five-year follow-up, RSA data from 61 patients were available and the mean maximum total point motion (MTPM) of the femoral components were: ATTUNE: 0.96 mm (95% confidence interval (CI) 0.79 to 1.14) and PFC-Sigma 1.37 mm (95% CI 1.18 to 1.59) (p < 0.001). The PFC-Sigma femoral component migrated more in the first postoperative year, but stabilized thereafter. MPTM of the tibial components were comparable at five-year follow-up: ATTUNE 1.12 mm (95% CI 0.95 to 1.31) and PFC-Sigma 1.25 mm (95% CI 1.07 to 1.44) (p = 0.438). RLL at the medial tibial implant-cement interface remained more prevalent for the ATTUNE at five-year follow-up compared to the PFC-Sigma (20% vs 3%). RLL did not progress over time, and varied between patients at different timepoints for both TKA systems. Clinical outcomes and PROMs improved compared with preoperative scores, and were not different between groups. Conclusion MTPM migration at five-year follow-up of the femoral and tibial component of the ATTUNE were similar and as low as that of the PFC-Sigma. MTPM migration of both knee implants did not significantly change from one year post-surgery, indicating stable fixation. Long-term ATTUNE performance may be expected to be comparable to the clinically well-performing PFC-Sigma. We have not found evidence of increased tibial component migration as measured by RSA to support concerns about cement debonding and a higher risk of aseptic loosening with the ATTUNE TKA.
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Affiliation(s)
- Yasin Yüksel
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
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Kalaai S, Most J, van Dun B, Kaptein BL, Tilman PBJ, Boonen B, Schotanus MGM. Less wear in deep-dished mobile compared to fixed bearing total knee arthroplasty of the same design at 5-year follow-up: a randomised controlled model-based Roentgen stereophotogrammetric analysis trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5137-5144. [PMID: 37796308 DOI: 10.1007/s00167-023-07584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this prospective randomised controlled study was to compare wear characteristics and functional outcome between deep-dished mobile bearing (MB) and fixed bearing (FB) cemented total knee arthroplasty (TKA). We hypothesised that deep-dished MB reduces polyethylene wear and improves patient-reported outcome measures. METHODS A total of 50 patients were randomised to receive a MB or FB tibia component of the same cemented TKA design. Patients were evaluated over a 5-year follow-up period. Medial and lateral wear were assessed using model-based Roentgen Stereophotogrammetric Analysis (RSA) and compared with the direct postoperative minimal joint space measurement. Functional outcome was assessed by the clinician-derived KSS and OKS, WOMAC, LEAS, and FJS-12. All data were derived using a general linear mixed model. RESULTS At 5-year follow-up, decreased wear in the MB compared to the FB group was observed on the lateral side (0.07 ± 0.17 mm, p = 0.026), but not on the medial side (0.31 ± 0.055 mm, p = 0.665). Functional outcomes improved with a statistical significant effect over time, with no significant differences between groups (all p > 0.17). CONCLUSION This model-based RSA study with 5-year follow-up showed that cemented deep-dished MB reduced lateral polyethylene wear as compared to FB in a single TKA system, whilst clinical outcomes were comparable. Longer follow-up is needed to establish clinical implications of these altered wear patterns and determine type of wear. LEVEL OF EVIDENCE Level 1 randomised controlled trial.
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Affiliation(s)
- S Kalaai
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | - J Most
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - B van Dun
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Imelda Hospital, Bonheiden, Belgium
| | - B L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P B J Tilman
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - B Boonen
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M G M Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
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Jørgensen PB, Kaptein BL, Søballe K, Jakobsen SS, Stilling M. Five-year polyethylene cup migration and PE wear of the Anatomic Dual Mobility acetabular construct. Arch Orthop Trauma Surg 2023; 143:5957-5965. [PMID: 36802237 PMCID: PMC9942043 DOI: 10.1007/s00402-023-04774-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/07/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature. Therefore, we measured migration and wear at 5-year follow-up using radiostereometric analysis (RSA). MATERIALS AND METHODS A cohort of 44 patients (mean age 73, 36 female) with heterogeneous indications for hip arthroplasty but all with a high risk of hip dislocation received total hip replacement (THA) with The Anatomic Dual Mobility X3 monoblock acetabular construct and a highly crosslinked polyethylene liner. RSA images and Oxford Hip Scores were obtained perioperatively and 1, 2, and 5 years postoperatively. Cup migration and polyethylene wear were calculated using RSA. RESULTS Mean 2-year proximal cup translation was 0.26 mm (95% CI 0.17; 0.36). Proximal cup translation was stable from 1- to 5-year follow-up. Mean 2-year cup inclination (z-rotation) was 0.23° (95% CI - 0.22; 0.68) and was greater in patients with osteoporosis compared to patients without osteoporosis (p = 0.04). Using 1-year follow-up as baseline, the 3D polyethylene wear rate was 0.07 mm/year (0.05; 0.10). Oxford hip scores improved 19 (95% CI 14; 24) points from mean 21 (range 4; 39) at baseline, to 40 (9; 48) 2 years postoperatively. There were no progressive radiolucent lines > 1 mm. There was 1 revision for offset correction. CONCLUSIONS Anatomic Dual Mobility monoblock cups were well-fixed, the polyethylene wear rate was low, and the clinical outcomes were good until 5-year follow-up suggesting good implant survival in patients of different age groups and with heterogeneous indications for THA.
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Affiliation(s)
- Peter Bo Jørgensen
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kjeld Søballe
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark
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Niesen AE, Kaptein BL, Hull ML. Conditions for Use and Implementation of Globally-Aligned Versus Local Baseplate Coordinate Systems When Computing Migration Using Radiostereometric Analysis. J Biomech Eng 2023; 145:1156501. [PMID: 36719252 DOI: 10.1115/1.4056802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
Radiostereometric analysis can be used for computing movement of a tibial baseplate relative to the tibia (termed migration) to determine stability of fixation. Quantifying migration in six degrees of freedom requires establishing a coordinate system in which to express the movement. Establishing consistent migration directions among patients and baseplate designs remains challenging. Deviations in imaging alignment (tibia/baseplate alignment during image acquisition) and surgical alignment (baseplate alignment on tibia) will affect computed migrations when using the conventional globally-aligned baseplate coordinate system (BCS) (defined by calibration box). Computing migration using a local BCS (defined by baseplate) may be preferrable. This paper (1) summarizes the migration equations when using a globally-aligned versus local BCS, (2) proposes a method for defining a local BCS, and (3) demonstrates differences in the two BCSs for an example patient whose baseplate has rotational deviations due to imaging or surgical alignments. Differences in migration for the two BCSs ranged from about ±0.5 mm in translations and -0.4 deg to 0.7 deg in rotations. Differences were largest for deviations in internal-external rotation and smallest for deviations in varus-valgus rotation. An example demonstrated that the globally-aligned BCS resulted in migration being quantified as subsidence instead of liftoff, thereby changing fundamental interpretations. Because migrations computed using a local BCS are independent of imaging and surgical alignments and instead characterize migration using baseplate features, a local BCS enhances consistency in migration directions among patients and baseplate designs relative to the interface in which fixation may be compromised.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis One Shields Avenue, Davis, CA 95616
| | - Bart L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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11
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de Ridder R, Kaptein BL, Pijls BG, Nelissen RGHH, Kaptijn HH. Five-year migration and insert wear of uncemented tibial components with either conventional polyethylene or sequentially annealed highly crosslinked polyethylene inserts: a blinded randomized controlled trial using radiostereometric analysis. Bone Joint J 2023; 105-B:518-525. [PMID: 37121577 DOI: 10.1302/0301-620x.105b5.bjj-2022-0986.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The primary objective of this study was to compare the five-year tibial component migration and wear between highly crosslinked polyethylene (HXLPE) inserts and conventional polyethylene (PE) inserts of the uncemented Triathlon fixed insert cruciate-retaining total knee arthroplasty (TKA). Secondary objectives included clinical outcomes and patient-reported outcome measures (PROMs). A double-blinded, randomized study was conducted including 96 TKAs. Tibial component migration and insert wear were measured with radiostereometric analysis (RSA) at three, six, 12, 24, and 60 months postoperatively. PROMS were collected preoperatively and at all follow-up timepoints. There was no clinically relevant difference in terms of tibial component migration, insert wear, and PROMs between the HXLPE and PE groups. The mean difference in tibial component migration (maximal total point migration (MTPM)) was 0.02 mm (95% confidence interval (CI) -0.07 to 0.11), which is below the value of 0.2 mm considered to be clinically relevant. Wear after five years for HXLPE was 0.16 mm (95% CI 0.05 to 0.27), and for PE was 0.23 mm (95% CI 0.12 to 0.35). The mean difference in wear rate was 0.01 mm/year (95% CI -0.02 to 0.05) in favour of the HXLPE group. Wear is mainly present on the medial side of the insert. There is no clinically relevant difference in tibial component migration and insert wear for up to five years between the HXLPE conventional PE inserts. For the implant studied, the potential advantages of a HXLPE insert remain to be proven under clinical conditions at longer-term follow-up.
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Affiliation(s)
- Ruud de Ridder
- Department of Orthopaedics, Lange Land Hospital Zoetermeer, Zoetermeer, Netherlands
- Reinier Haga Orthopaedic Centre, Zoetermeer, Netherlands
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, Netherlands
| | - Herman H Kaptijn
- Department of Orthopaedics, Lange Land Hospital Zoetermeer, Zoetermeer, Netherlands
- Reinier Haga Orthopaedic Centre, Zoetermeer, Netherlands
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12
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Koster LA, Rassir R, Kaptein BL, Sierevelt IN, Schager M, Nelissen RGHH, Nolte PA. A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty. Bone Joint J 2023; 105-B:148-157. [PMID: 36722052 DOI: 10.1302/0301-620x.105b2.bjj-2022-0414.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. METHODS A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. RESULTS The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. CONCLUSION The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected.Cite this article: Bone Joint J 2023;105-B(2):148-157.
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Affiliation(s)
- Lennard A Koster
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Rachid Rassir
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Inger N Sierevelt
- SCORE, Specialized Centre of Orthopedic Research and Education, Xpert Orthopedie Amsterdam, Amsterdam, Netherlands
| | - Marjolein Schager
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
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13
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Mills K, Wymenga AB, Bénard MR, Kaptein BL, Defoort KC, van Hellemondt GG, Heesterbeek PJC. Fluoroscopic and radiostereometric analysis of a bicruciate-retaining versus a posterior cruciate-retaining total knee arthroplasty: a randomized controlled trial. Bone Joint J 2023; 105-B:35-46. [PMID: 36587259 PMCID: PMC9948430 DOI: 10.1302/0301-620x.105b1.bjj-2022-0465.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The aim of this study was to compare a bicruciate-retaining (BCR) total knee arthroplasty (TKA) with a posterior cruciate-retaining (CR) TKA design in terms of kinematics, measured using fluoroscopy and stability as micromotion using radiostereometric analysis (RSA). METHODS A total of 40 patients with end-stage osteoarthritis were included in this randomized controlled trial. All patients performed a step-up and lunge task in front of a monoplane fluoroscope one year postoperatively. Femorotibial contact point (CP) locations were determined at every flexion angle and compared between the groups. RSA images were taken at baseline, six weeks, three, six, 12, and 24 months postoperatively. Clinical and functional outcomes were compared postoperatively for two years. RESULTS The BCR-TKA demonstrated a kinematic pattern comparable to the natural knee's screw-home mechanism in the step-up task. In the lunge task, the medial CP of the BCR-TKA was more anterior in the early flexion phase, while laterally the CP was more posterior during the entire movement cycle. The BCR-TKA group showed higher tibial migration. No differences were found for the clinical and functional outcomes. CONCLUSION The BCR-TKA shows a different kinematic pattern in early flexion/late extension compared to the CR-TKA. The difference between both implants is mostly visible in the flexion phase in which the anterior cruciate ligament is effective; however, both designs fail to fully replicate the motion of a natural knee. The higher migration of the BCR-TKA was concerning and highlights the importance of longer follow-up.Cite this article: Bone Joint J 2023;105-B(1):35-46.
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Affiliation(s)
- Kelly Mills
- Sint Maartenskliniek, Nijmegen, the Netherlands,Correspondence should be sent to Kelly Mills. E-mail:
| | | | | | - Bart L. Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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14
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van der Voort P, van Delft D, Valstar ER, Kaptein BL, Fiocco M, Nelissen RGHH. Migration behaviour of 2 clinically excellent cementless stems with different design rationales: 5-year follow-up of a randomised RSA-study. Hip Int 2022; 32:747-758. [PMID: 33596116 PMCID: PMC9726743 DOI: 10.1177/1120700021995482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Excellent long-term survival has been reported for both the Taperloc and the Mallory-Head cementless stems. However, little is known about the migration behaviour of these stems which have different design rationales. The purpose of this randomised clinical trial was to compare the migration and clinical outcomes of these stems during 5 years of follow-up. METHODS 42 consecutive hips in 38 patients scheduled to receive cementless THA were randomised to either a Taperloc or a Mallory-Head stem. Evaluation took place preoperatively and postoperatively on the second day, at 6, 12, 26, and 52 weeks, and annually thereafter. Primary outcome was stem migration measured using roentgen stereophotogrammetric analysis (RSA) and secondary outcomes were the Harris Hip Score (HHS) and 36-Item Short-Form Health Survey (SF-36). No patients were lost to follow-up; in 1 patient the THA was removed due to deep infection 3 months postoperatively. In 6 hips migration measurements were not possible due to insufficient marker configuration. RESULTS Throughout the follow-up period of 5 years, 3-dimensional migration was comparable between the Taperloc and the Mallory-Head stems (p-values > 0.05). However, at the 5-year follow-up point the retroversion of the Mallory-Head stem was 0.9° more than the Taperloc stem (p = 0.04). Initial subsidence and retroversion were respectively as large as 6.8 mm and 3.6° for the Taperloc stem and 5 mm and 3.6° for the Mallory-Head stem. After the first postoperative year, both implants had stabilised. The mean increment of HHS, as well as the SF-36 scores during the 5-year follow-up, were comparable between the 2 stems. CONCLUSIONS The excellent long-term survival of both designs was confirmed in this study showing comparable initial migration with subsequent stabilisation. However, the Taperloc design with a flat, wedged geometry showed better rotational stability.
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Affiliation(s)
- Paul van der Voort
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands,Paul van der Voort, Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, P.O. Box 9600, Leiden, 2333 ZA, The Netherlands.
| | - Danny van Delft
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | - Edward R Valstar
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology Delft, The Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Rob GHH Nelissen
- Department of Orthopaedics, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
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15
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Jürgens-Lahnstein JH, Petersen ET, Laursen M, Hauskov Iversen C, Kaptein BL, Lindgren L, Stilling M. Development, construction, and validation of a thinner uniplanar calibration cage for radiostereometry. J Orthop Res 2022; 40:1645-1653. [PMID: 34664740 DOI: 10.1002/jor.25193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
Radiostereometric analysis (RSA) is an accurate and precise radiographic method that can be used to measure micromotion of implants and study joint kinematics in vivo. A calibration cage with radiopaque markers is used to calibrate the RSA images; however, the thickness (250 mm) of the calibration cage restricts the available area for the patient and equipment during RSA recordings. A thinner calibration cage would increase the recording area, facilitate handling of the cage, and ease integration of the cage with the RSA system. We developed a thinner calibration cage without compromise of accuracy and precision. First, we performed numerical simulations of an RSA system, and showed that the calibration cage thickness could be decreased to 140 mm maintaining accuracy and precision using 40 fiducial and 30 control markers. Second, we constructed a new calibration cage (NRT cage) according to the simulation results. Third, we validated the new calibration cage against two state-of-the-art calibration cages (Umeaa cage and Leiden cage) in a phantom study. All cages performed similar for marker-based analysis, except for y-rotation, where the Umeaa cage (SD = 0.064 mm) was less precise compared to the NRT (SD = 0.038 mm) and Leiden cages (0.042 mm) (p = .01). For model-based analysis the NRT cage had superior precision for translations (SD ≤ 0.054 mm) over the Leiden cage (SD ≤ 0.118 mm) and Umeaa cage (SD ≤ 0.093 mm) (p < .01). The combined study confirmed that the new and thinner calibration cage maintained accuracy and precision at the level of existing thicker calibration cages.
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Affiliation(s)
| | - Emil Toft Petersen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mogens Laursen
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lars Lindgren
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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17
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Koster LA, Kaptein BL, Pijls BG, Nelissen RG. Letter to the Editor: How Large a Study is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis. Clin Orthop Relat Res 2022; 480:836-837. [PMID: 35081049 PMCID: PMC8923568 DOI: 10.1097/corr.0000000000002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lennard A. Koster
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart L. Kaptein
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart G. Pijls
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G.H.H. Nelissen
- marked for authors Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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18
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Jørgensen PB, Kaptein BL, Søballe K, Jakobsen SS, Stilling M. Combined and hybrid marker models for radiostereometry assessment of polyethylene liner motion in dual mobility hip prosthesis: a proof-of-concept study. Eur Radiol Exp 2021; 5:55. [PMID: 34907467 PMCID: PMC8671599 DOI: 10.1186/s41747-021-00253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Investigation of polyethylene liner movement in total hip arthroplasty requires bead-marking for radiographic visibility of the liner. However, occlusion of markers poses a challenge for marker registration in radiographs. Methods The polyethylene of a dual mobility acetabular system was marked with twelve 1-mm tantalum markers (four groups of three markers) using a custom-made drill guide. Liner motion in a phantom and a patient was investigated with dynamic radiostereometry analysis (dRSA) at 1-year follow-up and static radiostereometry analysis (sRSA) postoperatively and at 1- and 2-year follow-up. A combined marker configuration (CMC) model was calculated from the registered positions of the liner markers and the femoral head in several images. Furthermore, the CMC model and the theoretic marker positions from computer-assisted models of the drill guide were combined in a hybrid model. Results The CMC model included eleven markers in the phantom and nine markers in the patient, which was sufficient for dRSA. Liner movement in the phantom followed liner contact with the femoral neck, while liner movement in the patient was independent. The hybrid model was necessary to determine liner orientation in sRSA recordings, which clearly changed from postoperative to 1- and 2-year follow-up even though the patient was positioned similarly. Conclusion Polyethylene liner motion in dual mobility hip prosthesis can be assessed with CMC models in dRSA recordings. In sRSA, the liner position between follow-ups is unpredictable and analysis requires inclusion of all markers in the model, accomplished with a hybrid marker model. Trial registration ClinicalTrials.gov [NCT02301182], 25 October 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00253-x.
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Affiliation(s)
- Peter Bo Jørgensen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark.
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, 2333, Leiden, ZA, The Netherlands
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
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19
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Hasan S, Kaptein BL, Nelissen RGHH, van Hamersveld KT, Toksvig-Larsen S, Marang-van de Mheen PJ. The Influence of Postoperative Coronal Alignment on Tibial Migration After Total Knee Arthroplasty in Preoperative Varus and Valgus Knees: A Secondary Analysis of 10 Randomized Controlled Trials Using Radiostereometric Analysis. J Bone Joint Surg Am 2021; 103:2281-2290. [PMID: 34648477 DOI: 10.2106/jbjs.20.01659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Orthopaedic surgeons aim for mechanical alignment when performing total knee arthroplasty (TKA) as malalignment is associated with loosening. Loosening may be predicted by migration as measured with radiostereometric analysis (RSA), but previous RSA studies on postoperative alignment have shown contradictory results and have been limited to cemented implants and small numbers of patients. Therefore, we performed a secondary analysis of 10 previously published randomized controlled trials (RCTs) to compare migration between postoperative in-range and out-of-range cemented and uncemented TKA implants among patients with a preoperative varus or valgus knee. METHODS All RCTs involving the use of RSA that had been conducted at 2 centers were included. Alignment was classified, with use of the hip-knee-ankle angle (HKA), as in-range (0° ± 3°) or out-of-range (<-3° or >3°). The fixation methods included cemented, uncemented-coated, and uncemented-uncoated. Migration was measured at 3, 12, and 24 months. A linear mixed model was used, with adjustment for fixation method and clustering of patients within centers. RESULTS Of 476 TKA implants that had been out-of-range preoperatively, 290 were in-range postoperatively and 186 were out-of-range in either varus (n = 143) or valgus (n = 43) postoperatively. The mean migration at 3, 12, and 24 months was 0.73 mm (95% confidence interval [CI], 0.66 to 0.79 mm), 0.92 mm (95% CI, 0.85 to 1.00 mm), and 0.97 mm (95% CI, 0.90 to 1.05 mm), respectively, for the in-range group and 0.80 mm (95% CI, 0.72 to 0.87 mm), 0.98 (95% CI, 0.90 to 1.07 mm), and 1.04 mm (95% CI, 0.95 to 1.13 mm), respectively, for the out-of-range group (p = 0.07). The fixation method significantly influenced migration, with uncemented-uncoated implants migrating more than cemented and uncemented-coated implants (p < 0.001). CONCLUSIONS Postoperative alignment did not influence migration of TKAs in the first 2 postoperative years in patients with preoperative varus or valgus alignment of the knee. However, the fixation method significantly influenced migration, with uncemented-uncoated implants showing the greatest migration. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen T van Hamersveld
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
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20
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Pijpker PAJ, Kuijlen JMA, Kaptein BL, Pondaag W. Three-Dimensional-Printed Drill Guides for Occipitothoracic Fusion in a Pediatric Patient With Occipitocervical Instability. Oper Neurosurg (Hagerstown) 2021; 21:27-33. [PMID: 33728473 PMCID: PMC8203425 DOI: 10.1093/ons/opab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric occipitothoracic fusion can be challenging because of small size pedicles and thin occipital bone. Three-dimensional (3D) printing technology can help with accurate screw insertion but has not been described for occipital keel plate positioning so far. OBJECTIVE To describe the novel use of 3D technology to position occipital keel plates during pediatric occipitothoracic fixation. METHODS A young boy with segmental spinal dysgenesis presented with asymmetrical pyramidal paresis in all limbs. Developmental abnormities of the cervical spine caused a thinned spinal cord, and because of progressive spinal cord compression, surgical intervention by means of occipitothoracic fixation was indicated at the age of 3 yr.Because of the small-size pedicles and thin occipital bone, the pedicle screws and occipital plates were planned meticulously using 3D virtual surgical planning technology. The rods were virtually bent in order to properly align with the planned screws. By means of 3D-printed guides, the surgical plan was transferred to the operating theater. For the occipital bone, a novel guide concept was developed, aiming for screw positions at maximal bone thickness. RESULTS The postoperative course was uneventful, and radiographs showed good cervical alignment. After superimposing the virtual plan with the intraoperative acquired computed tomography, it was confirmed that the occipital plate positions matched the virtual plan and that pedicle screws were accurately inserted without signs of breach. CONCLUSION The use of 3D technology has greatly facilitated the performance of the occipitothoracic fixation and could, in the future, contribute to safer pediatric spinal fixation procedures.
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Affiliation(s)
- Peter A J Pijpker
- 3D lab, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jos M A Kuijlen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Willem Pondaag
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
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21
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Koster LA, Meinardi JE, Kaptein BL, Van der Linden-Van der Zwaag E, Nelissen RGHH. Two-year RSA migration results of symmetrical and asymmetrical tibial components in total knee arthroplasty: a randomized controlled trial. Bone Joint J 2021; 103-B:855-863. [PMID: 33934647 DOI: 10.1302/0301-620x.103b5.bjj-2020-1575.r2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The objective of this study was to compare the two-year migration pattern and clinical outcomes of a total knee arthroplasty (TKA) with an asymmetrical tibial design (Persona PS) and a well-proven TKA with a symmetrical tibial design (NexGen LPS). METHODS A randomized controlled radiostereometric analysis (RSA) trial was conducted including 75 cemented posterior-stabilized TKAs. Implant migration was measured with RSA. Maximum total point motion (MTPM), translations, rotations, clinical outcomes, and patient-reported outcome measures (PROMs) were assessed at one week postoperatively and at three, six, 12, and 24 months postoperatively. RESULTS A linear mixed-effect model using RSA data of 31 asymmetrical and 38 symmetrical TKAs did not show a difference in mean MTPM migration pattern of the tibial or femoral components. Mean tibial component MTPM at two years postoperative of the asymmetrical TKA design was 0.93 mm and 1.00 mm for the symmetrical design. For the femoral component these values were 1.04 mm and 1.14 mm, respectively. No significant differences were observed in other migration parameters or in clinical and PROM measurements. CONCLUSION The TKA design with an asymmetrical tibial component has comparable component migration with the proven TKA with a symmetrical tibial component. This suggests the risk of long-term aseptic loosening of the two designs is comparable. Cite this article: Bone Joint J 2021;103-B(5):855-863.
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Affiliation(s)
- Lennard A Koster
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris E Meinardi
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Rob G H H Nelissen
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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22
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Campi S, Kendrick BJL, Kaptein BL, Valstar ER, Jackson WFM, Dodd CAF, Price AJ, Murray DW. Five-year results of a randomised controlled trial comparing cemented and cementless Oxford unicompartmental knee replacement using radiostereometric analysis. Knee 2021; 28:383-390. [PMID: 33408039 DOI: 10.1016/j.knee.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/18/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR). The aim of this study was to determine if cementless UKR fixation is as good as cemented by comparing the five-year migration measured radiostereometric analysis (RSA) in a randomised controlled trial. METHODS Thirty-nine patients were randomised to receive either a cemented or a cementless Oxford UKR and were studied at intervals up to five years to assess migration with RSA and radiolucencies with radiographs. RESULTS During the first year there was a small and significant amount of migration, predominantly in an anterior direction, of both the cemented (0.24 mm, SD 0.32, p = 0.01) and cementless (0.26 mm, SD 0.31, p = 0.00) femoral components. Thereafter there was no significant migration in any direction. At no stage was there any significant difference between the migrations of the cemented or cementless femoral components. During the first year, particularly the first three months, the cementless tibial components subsided 0.28 mm (SD 0.19, p = 0.00). This was significantly (p = 0.00) greater than the subsidence of the cemented tibial component (0.09, SD 0.19, p = 0.28). Between the second and fifth years there was no significant migration of either cemented or cementless tibial components. At five years radiolucent lines occurred significantly less with cementless (one partial) compared to cemented (six partial and one complete) tibial components. CONCLUSIONS As, between two and five years, there was no significant migration of cemented or cementless components, and no significant difference between them, we conclude that cementless fixation is as reliable as cemented. It may be better as there are fewer radiolucent lines.
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Affiliation(s)
- S Campi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - B J L Kendrick
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - W F M Jackson
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - C A F Dodd
- Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - A J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK; Nuffield Orthopaedic Centre, NHS Foundation Trust, Oxford, UK.
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23
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Van Der Voort P, D Klein Nulent ML, Valstar ER, Kaptein BL, Fiocco M, G H H Nelissen R. Long-term migration of a cementless stem with different bioactive coatings. Data from a "prime" RSA study: lessons learned. Acta Orthop 2020; 91:660-668. [PMID: 33143507 PMCID: PMC8023916 DOI: 10.1080/17453674.2020.1840021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Little is known about the long-term migration pattern of cementless stems in total hip arthroplasty (THA). Furthermore, the role of bioactive coatings in fixation, and thus migration, remains uncertain. Hydroxyapatite (HA) is the most commonly used bioactive coating. However, delamination of the coating might induce loosening. Alternatively, fluorapatite (FA) has proved to be more thermostable than HA, thereby potentially increasing longevity. We assessed the long-term migration of cementless stems with different coatings using radiostereometric analysis (RSA), thereby establishing a reference for acceptable migration. Patients and methods - 61 THAs in 53 patients were randomized to receive either a HA, FA, or uncoated Mallory-Head Porous stem during the years 1992 to 1994. Primary outcome was stem migration measured using RSA and secondary outcome was the Harris Hip Score (HHS). Evaluation took place preoperatively and postoperatively on the second day, at 6, 12, 25 and 52 weeks, and annually thereafter. At the 25-year follow-up, 12 patients (17 THAs) had died and 1 patient (1 THA) was lost to follow-up. Due to the high number of missing second-day postoperative RSA radiographs, the 1-year postoperative RSA radiograph was used as baseline for the comparative analyses. Results - Mean follow-up was 17 years (SD 6.6). All stems showed initial rapid migration with median subsidence of 0.2 mm (-0.1 to 0.6) and median retroversion of 0.9° (-3.2 to 2) at 12 months, followed by stable migration reaching a plateau phase. No stem was revised, albeit 1 stem showed continuous subsidence up to 1.5 mm. Comparing the different coatings, we could not find a statistically significant difference in overall 25-year migration (p-values > 0.05). Median subsidence at 15-year follow-up was for HA -0.1 mm (-0.4 to 0.2), for FA 0 mm (-0.1 to 0.2), and for uncoated stems 0.2 mm (-0.1 to 0.5). Median internal rotation at 15-year follow-up was for HA not available, for FA 1.1° (-0.5 to 2.6), and for uncoated stems 0° (-0.5 to 0.4). HHS were also comparable (p-values > 0.05), with at 15-year follow-up for HA 85 points (41-99), for FA 76 points (61-90), and for uncoated stems 79 points (74-90). Interpretation - The long-term migration pattern of cementless stems using different bioactive coatings has not previously been described. No beneficial effect, or side effect at long-term follow-up of bioactive coatings, was found. The provided migration data can be used in future research to establish thresholds for acceptable migration patterns cementless stem designs.
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Affiliation(s)
- Paul Van Der Voort
- Department of Orthopaedics, Leiden University Medical Center, Leiden; ,Correspondence:
| | | | - Edward R Valstar
- Department of Orthopaedics, Leiden University Medical Center, Leiden; ,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, University of Technology Delft, Delft;
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden;
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden; ,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden; ,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, University of Technology Delft, Delft;
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24
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Tilbury C, Leichtenberg CS, Kaptein BL, Koster LA, Verdegaal SHM, Onstenk R, der Zwaag HMJVDLV, Krips R, Kaptijn HH, Vehmeijer SBW, Marijnissen WJCM, Meesters JJL, van Rooden SM, Brand R, Nelissen RGHH, Gademan MGJ, Vlieland TPMV. Feasibility of Collecting Multiple Patient-Reported Outcome Measures Alongside the Dutch Arthroplasty Register. J Patient Exp 2020; 7:484-492. [PMID: 33062868 PMCID: PMC7534142 DOI: 10.1177/2374373519853166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Compliance rates with patient-reported outcome measures (PROMs) collected alongside arthroplasty registries vary in the literature. We described the feasibility of a routinely collected set PROMs alongside the Dutch Arthroplasty Register. Methods: The longitudinal Leiden Orthopaedics Outcomes of OsteoArthritis Study is a multicenter (7 hospitals), observational study including patients undergoing total hip or total knee arthroplasty (THA or TKA). A set of PROMs: Short Form-12, EuroQol 5 Dimensions, Hip/Knee injury and Osteoarthritis Outcome Score, Oxford Hip/Knee Score was collected preoperatively and at 6, 12, 24 months, and every 2 years thereafter. Participation rates and response rates were recorded. Results: Between June 2012 and December 2014, 1796 THA and 1636 TKA patients were invited, of whom 1043 THA (58%; mean age 68 years [standard deviation, SD: 10]) and 970 TKA patients (59%; mean age 71 years [SD 9.5]) participated in the study. At 6 months, 35 THA/38 TKA patients were lost to follow-up. Response rates were 90% for THA (898/1000) and 89% for TKA (827/932) participants. At 1 and 2 years, 8 and 18 THA and 17 and 11 TKA patients were lost to follow-up, respectively. The response rates among those eligible were 87% (866/992) and 84% (812/972) for THA and 84% (771/917) and 83% (756/906) for TKA patients, respectively. The 2-year questionnaire was completed by 78.5% of the included THA patients and by 77.9% of the included TKA patients. Conclusions: About 60% of patients undergoing THA or TKA complete PROMs preoperatively, with more than 80% returning follow-up PROMs. To increase the participation rates, more efforts concerning the initial recruitment of patients are needed.
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Affiliation(s)
- Claire Tilbury
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Suzan H M Verdegaal
- Department of Orthopaedics, Alrijne Ziekenhuis Leiderdorp, Leiderdorp, the Netherlands
| | - Ron Onstenk
- Department of Orthopaedics, Groene Hart Ziekenhuis, Gouda, the Netherlands
| | | | - Rover Krips
- Department of Orthopaedics, Alrijne Ziekenhuis Leiderdorp, Leiderdorp, the Netherlands
| | - Herman H Kaptijn
- Department of Orthopaedics, LangeLand Ziekenhuis, Zoetermeer, the Netherlands
| | | | | | - Jorit J L Meesters
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephanie M van Rooden
- Department of Advanced Data Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Ronald Brand
- Department of Advanced Data Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.,Basalt Rehabilitation, Leiden/The Hague, the Netherlands
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25
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Kaptein BL, den Hollander P, Thomassen B, Fiocco M, Nelissen RGHH. A randomized controlled trial comparing tibial migration of the ATTUNE cemented cruciate-retaining knee prosthesis with the PFC-sigma design. Bone Joint J 2020; 102-B:1158-1166. [PMID: 32862688 PMCID: PMC7468556 DOI: 10.1302/0301-620x.102b9.bjj-2020-0096.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS The primary objective of this study was to compare migration of the cemented ATTUNE fixed bearing cruciate retaining tibial component with the cemented Press-Fit Condylar (PFC)-sigma fixed bearing cruciate retaining tibial component. The secondary objectives included comparing clinical and radiological outcomes and Patient Reported Outcome Measures (PROMs). METHODS A single blinded randomized, non-inferiority study was conducted including 74 patients. Radiostereometry examinations were made after weight bearing, but before hospital discharge, and at three, six, 12, and 24 months postoperatively. PROMS were collected preoperatively and at three, six, 12, and 24 months postoperatively. Radiographs for measuring radiolucencies were collected at two weeks and two years postoperatively. RESULTS The overall migration (mean maximum total point motion (MPTM)) at two years was comparable: mean 1.13 mm (95% confidence interval (CI), 0.97 to 1.30) for the ATTUNE and 1.16 mm (95% CI, 0.99 to 1.35) for the PFC-sigma. At two years, the mean backward tilting was -0.43° (95% CI, -0.65 to -0.21) for the ATTUNE and 0.08° (95% CI -0.16 to 0.31), for the PFC-sigma. Overall migration between the first and second postoperative year was negligible for both components. The clinical outcomes and PROMs improved compared with preoperative scores and were not different between groups. Radiolucencies at the implant-cement interface were mainly seen below the medial baseplate: 17% in the ATTUNE and 3% in the PFC-sigma at two weeks, and at two years 42% and 9% respectively (p = 0.001). CONCLUSION In the first two postoperative years the initial version of the ATTUNE tibial component was not inferior with respect to overall migration, although it showed relatively more backwards tilting and radiolucent lines at the implant-cement interface than the PFC-sigma. The version of the ATTUNE tibial component examined in this study has subsequently undergone modification by the manufacturer. Level of Evidence: 1 (randomized controlled clinical trial) Cite this article: Bone Joint J 2020;102-B(9):1158-1166.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Peter den Hollander
- Department of Orthopaedic Surgery, Haaglanden Medical Center, The Hague, Netherlands
| | - Bregje Thomassen
- Faculty Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Martha Fiocco
- Mathematical Institute, Leiden University, Leiden, The Netherlands.,Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
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26
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Hasan S, van Hamersveld KT, Marang-van de Mheen PJ, Kaptein BL, Nelissen RGHH, Toksvig-Larsen S. Migration of a novel 3D-printed cementless versus a cemented total knee arthroplasty: two-year results of a randomized controlled trial using radiostereometric analysis. Bone Joint J 2020; 102-B:1016-1024. [DOI: 10.1302/0301-620x.102b8.bjj-2020-0054.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims Although bone cement is the primary mode of fixation in total knee arthroplasty (TKA), cementless fixation is gaining interest as it has the potential of achieving lasting biological fixation. By 3D printing an implant, highly porous structures can be manufactured, promoting osseointegration into the implant to prevent aseptic loosening. This study compares the migration of cementless, 3D-printed TKA to cemented TKA of a similar design up to two years of follow-up using radiostereometric analysis (RSA) known for its ability to predict aseptic loosening. Methods A total of 72 patients were randomized to either cementless 3D-printed or a cemented cruciate retaining TKA. RSA and clinical scores were evaluated at baseline and postoperatively at three, 12, and 24 months. A mixed model was used to analyze the repeated measurements. Results The mean maximum total point motion (MTPM) at three, 12, and 24 months was 0.33 mm (95% confidence interval (CI) 0.25 to 0.42), 0.42 mm (95% CI 0.33 to 0.51), and 0.47 mm (95% CI 0.38 to 0.57) respectively in the cemented group, versus 0.52 mm (95% CI 0.43 to 0.63), 0.62 mm (95% CI 0.52 to 0.73), and 0.64 mm (95% CI 0.53 to 0.75) in the cementless group (p = 0.003). However, using three months as baseline, no difference in mean migration between groups was found (p = 0.497). Three implants in the cemented group showed a > 0.2 mm increase in MTPM between one and two years of follow-up. In the cementless group, one implant was revised due to pain and progressive migration, and one patient had a liner-exchange due to a deep infection. Conclusion The cementless TKA migrated more than the cemented TKA in the first two-year period. This difference was mainly due to a higher initial migration of the cementless TKA in the first three postoperative months after which stabilization was observed in all but one malaligned and early revised TKA. Whether the biological fixation of the cementless implants will result in an increased long-term survivorship requires a longer follow-up. Cite this article: Bone Joint J 2020;102-B(8):1016–1024.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Koen T. van Hamersveld
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Bart L. Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Sören Toksvig-Larsen
- Department of Orthopaedic Surgery, Hässleholm Hospital, Hässleholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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27
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Abstract
Background and purpose - The uncemented Symax hip stem has shown early proximal ingrowth as result of the BONIT-hydroxyapatite (HA) coating and the distal DOTIZE surface treatment. We evaluated 2-year postoperative radiostereometric analysis (RSA) migration of the Symax hip stem in THA patients. We also investigated the correlation between migration at 4 weeks and clinical outcomes after 2 years.Patients and methods - Patients in a 2-year clinical follow-up single-centre RSA randomized controlled trial were randomized to 2 different cup designs. All 45 patients received a Symax hip stem. RSA migration patterns of the Symax hip stem is presented here as a single cohort. RSA examinations were performed postoperatively, but before weight-bearing, and subsequently after 1, 3, 6, 12, and 24 months. Clinical outcomes and radiographic evaluations were assessed 3, 6, 12, and 24 months postoperatively.Results - During the first 4 weeks, the Symax hip stem subsided, rotated into retroversion, and translated posteriorly, after which the migration ceased and the prosthesis stabilized. All clinical outcomes improved from preoperatively to 2 years. There was no clinically or statistically significant correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years.Interpretation - RSA evaluation of the uncemented Symax hip stem confirms that the design principles and coating properties lead to early stabilization of the stem, as early as 4 weeks postoperatively. There was no correlation between subsidence and retroversion at 4 weeks and clinical outcomes after 2 years. Based on the predictive potential of the RSA technique, we anticipate excellent long-term survival of this hip stem.
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Affiliation(s)
- Dennis S M G Kruijntjens
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht; ,Correspondence:
| | - Lennard Koster
- Department of Orthopaedic Surgery, RSAcore, Leiden University Medical Centre, Leiden, the Netherlands
| | - Bart L Kaptein
- Department of Orthopaedic Surgery, RSAcore, Leiden University Medical Centre, Leiden, the Netherlands
| | - Liesbeth M C Jutten
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Research School Caphri, Maastricht University Medical Centre, Maastricht;
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28
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Hasan S, Marang-Van De Mheen PJ, Kaptein BL, Nelissen RGHH, Toksvig-Larsen S. All-polyethylene versus metal-backed posterior stabilized total knee arthroplasty: similar 2-year results of a randomized radiostereometric analysis study. Acta Orthop 2019; 90:590-595. [PMID: 31550947 PMCID: PMC6844393 DOI: 10.1080/17453674.2019.1668602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The all-polyethylene tibial (APT) component, introduced in the early 1970s, was surpassed by metal-backed tibial (MBT) trays as the first choice for total knee arthroplasty (TKA). With improved polyethylene, the modern APT components can reduce costs, and have shown equivalent results in survivorship and early migration of the cruciate-retaining and cruciate-stabilizing designs. This study compares the 2-year migration of a similarly designed APT-posterior stabilized (PS) and a MBT-PS TKA, using radiostereometric analysis (RSA).Patients and methods - 60 patients were randomized to receive either an APT Triathlon PS or an MBT Triathlon PS TKA (Stryker, NJ, USA). Migration measured by RSA and clinical scores were evaluated at baseline and at 3, 12, and 24 months postoperatively. Repeated measurements were analyzed with a linear mixed model and generalized estimating equations.Results - The mean maximum total point movement (MTPM) at 3, 12, and 24 months was 0.41 mm (95% CI 0.33-0.50), 0.57 mm (0.44-0.70), and 0.56 mm (0.42-0.69) respectively in the MBT group and 0.46 mm (0.36-0.57), 0.61 mm (0.49-0.73), and 0.64 mm (0.50-0.77) in the APT group. 2 MBT and 1 APT implant were considered unstable at the 2-year follow-up. The KSS Knee score and KSS Function across 3, 12, and 24 months were comparable in both groups.Interpretation - For an APT-PS designed component, MTPM measured with RSA is comparable to the MBT-PS component after 2 years of follow-up. No differences in complications or clinical outcomes were found.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; ,Correspondence:
| | | | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands;
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands;
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden
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29
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van Hamersveld KT, Marang–van de Mheen PJ, Koster LA, Nelissen RGHH, Toksvig-Larsen S, Kaptein BL. Marker-based versus model-based radiostereometric analysis of total knee arthroplasty migration: a reanalysis with comparable mean outcomes despite distinct types of measurement error. Acta Orthop 2019; 90:366-372. [PMID: 31017513 PMCID: PMC7025693 DOI: 10.1080/17453674.2019.1605692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Pooling data of studies evaluating total knee arthroplasty migration using radiostereometric analysis (RSA) may be compromised when the RSA method used would influence estimated differences between groups. We therefore reanalyzed a marker-based RSA study with model-based RSA to assess possible limitations of each RSA method, including insert micromotions in modular TKA and their effect on estimated group differences. Patients and methods - All patients had received a cemented Triathlon implant (Stryker, Mahwah, NJ, USA) with either an all-polyethylene (n = 29) or a metal-backed (n = 28) tibial component. The latter group was reanalyzed with model-based RSA. Precision of each RSA method was calculated using double examinations. Bland-Altman plots were constructed to determine the limits of agreement between the 2 RSA methods. Polyethylene insert micromotion was quantified by measuring migration with respect to the metal tray. Finally, analyses of the original study were repeated with the model-based RSA results. Results - Systematic differences were found in translations between marker-based and model-based RSA as a result of different reference origins being used for migration calculations. Micromotions of the polyethylene insert within the metal tray were negligibly small. Mean migration results were comparable between marker-based and model-based RSA when using the same reference origin, even though conclusions on individual patients may differ between RSA methods due to various types of measurement error (e.g., marker occlusion and model-fit inaccuracies). Interpretation - At least for the studied TKA design, pooling mean migration data of different RSA methods appears justified. For translations, however, adjustments should be made to correct for differences in reference origin. Migration patterns of individual patients may differ as a result of distinct types of measurement error.
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Affiliation(s)
- Koen T van Hamersveld
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; ,Correspondence:
| | | | - Lennard A Koster
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands;
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands;
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands;
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Horsager K, Madsen F, Odgaard A, Fink Jepsen C, Rømer L, Kristensen PW, Kaptein BL, Søballe K, Stilling M. Similar polyethylene wear between cemented and cementless Oxford medial UKA: a 5-year follow-up randomized controlled trial on 79 patients using radiostereometry. Acta Orthop 2019; 90:67-73. [PMID: 30526183 PMCID: PMC6366473 DOI: 10.1080/17453674.2018.1543757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hydroxyapatite (HA)-coated implants have been associated with high polyethylene wear in hip arthroplasties. HA coating as a promoter of wear in knee arthroplasties has not been investigated. We compared the wear-rate of the polyethylene bearing for cemented and cementless HA-coated Oxford medial unicondylar knee arthroplasties (UKA). Secondarily, we investigated whether wear-rates were influenced by overhang or impingement of the bearing. Patients and methods - 80 patients (mean age 64 years), treatment-blinded, were randomized to 1 of 3 Oxford medial UKA versions: cemented with double-pegged or single-pegged femoral component or cementless HA-coated with double-pegged femoral component (ratios 1:1:1). We compared wear between the cemented (n = 55) and cementless group (n = 25) (ratio 2:1). Wear, impingement, and overhang were quantified between surgery and 5-year follow-up using radiostereometry. Clinical outcome was evaluated with the Oxford Knee Score. Results - The mean wear-rate for patients without bearing overhang was 0.04 mm/year (95% CI 0.02-0.07) for the cemented group and 0.05 mm/year (CI 0.02-0.08) for the cementless group. The mean difference in wear was 0.008 mm/year (CI -0.04 to 0.03). No impingement was identified. Half of the patients had medial bearing overhang, mean 2.5 mm (1-5). Wear increased by 0.014 mm/year for each mm increment in overhang. The mean Oxford Knee Score was 39 for the cementless group and 38 for the cemented group at the 5-year follow-up. Interpretation - The wear-rates were similar for the 2 fixation methods, which supports further use of the cementless Oxford medial UKA. However, a caveat is a relatively large 95% CI of the mean difference in wear-rate. Component size and position is important as half of the patients presented with an additional increase in wear-rate due to medial bearing overhang.
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Affiliation(s)
- Kristian Horsager
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark; ,Correspondence:
| | - Frank Madsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark;
| | - Anders Odgaard
- Department of Orthopaedics, Herlev-Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark;
| | - Claus Fink Jepsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark;
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark;
| | | | - Bart L Kaptein
- Department of Orthopedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, Netherlands
| | - Kjeld Søballe
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark;
| | - Maiken Stilling
- Department of Clinical Institute, Aarhus University, Aarhus, Denmark;
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Horsager K, Kaptein BL, Jørgensen PB, Jepsen CF, Stilling M. Oxford medial unicompartmental knees display contact-loss during step-cycle motion and bicycle motion: A dynamic radiostereometric study. J Orthop Res 2018; 36:357-364. [PMID: 28574622 DOI: 10.1002/jor.23625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/28/2017] [Indexed: 02/04/2023]
Abstract
The Oxford medial unicompartmental knee is designed fully congruent, with the purpose of maintaining a large contact-area throughout motion and minimize wear. No other study has investigated this design feature in-vivo. We aimed to evaluate if contact-loss was introduced between the articulating surfaces of the Oxford medial unicompartmental knee during bicycle- and step-cycle motion, and whether this correlated with essential implant parameters, such as polyethylene (PE) wear, knee-loadings, and clinical outcome. To study contact-loss, 15 patients (12 males, mean age 69 years) with an Oxford medial unicompartmental knee (7 cemented, mean follow-up 4.4 years) were examined with use of dynamic radiostereometry (RSA) (10 frames/s). PE wear was measured from static RSA and clinical outcome was evaluated with American Knee Society Score (AKSS) and Oxford Knee Score (OKS). Data on knee-loadings were acquired from the literature. Contact-loss was deteced in all patients during both exercises, and the trend of contact-loss correlated with the knee-loadings. Median contact-loss was 0.8 mm (95%PI: 0.3; 1.5) for bicycle motion and 0.3 mm (95%PI: 0.24; 0.35) for step-cycle motion, and did not correlate with the PE wear rate of mean 0.06 mm/year. Possible in-congruency was seen in three patients. Clinical outcome scores correlated with contact-loss during step-cycle motion. In conclusion, contact-loss was seen in all patients indicating a clinical tolerance during load. Contact-loss followed the knee-loadings, which could explain why no correlation was seen with PE wear, as an increase in load was acommadated by an increase in contact-area (contact-loss reduction). The size of contact-loss may reflect clinical outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:357-364, 2018.
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Affiliation(s)
- Kristian Horsager
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
| | - Peter B Jørgensen
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Claus F Jepsen
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus, Denmark
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Schotanus MGM, Pilot P, Kaptein BL, Draijer WF, Tilman PBJ, Vos R, Kort NP. No difference in terms of radiostereometric analysis between fixed- and mobile-bearing total knee arthroplasty: a randomized, single-blind, controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2978-2985. [PMID: 27120194 DOI: 10.1007/s00167-016-4138-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE A concern that arises with any new prosthesis is whether it will achieve satisfactory long-term implant stability. The gold standard of assessing the quality of fixation in a new or relatively new implant is to undertake a randomized controlled trial using radiostereometric analysis. It was hypothesized that both mobile-bearing total knee arthroplasty and fixed-bearing total knee arthroplasty have comparable migration patterns at 2-year follow-up. This study investigated two types of cemented total knee arthroplasty, the mobile- or fixed-bearing variant from the same family with use of radiostereometric analysis. METHODS This prospective, patient-blinded, randomized, controlled trial was designed to investigate early migration of the tibia component after two years of follow-up with use of radiostereometric analysis. A total of 50 patients were randomized to receive a mobile- or fixed-bearing TKA from the same family. Patients were evaluated during 2-year follow-up, including radiostereometric analysis, physical and clinical examination and patient reported outcome measures (PROMs). RESULTS At two-year follow-up, the mean (±SD) maximum total point motion (MTPM) in the fixed-bearing group was 0.82 (±1.16) versus 0.92 mm (±0.64) in the mobile-bearing group (p = n.s) with the largest migration seen during the first 6 weeks (0.45 ± 0.32 vs. 0.54 ± 0.30). The clinical outcome and PROMs significantly improved within each group, not between both groups. CONCLUSIONS Measuring early micromotion is useful for predicting clinical loosening that can lead to revision. The results of this study demonstrate that early migration of the mobile-bearing is similar to that of the fixed-bearing component at two years and was mainly seen in the first weeks after implantation. LEVEL OF EVIDENCE Randomized, single-blind, controlled trial, Level I.
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Affiliation(s)
- M G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
| | - P Pilot
- Department of Orthopaedic Surgery, Reinier de Graafweg Hospital, Delft, The Netherlands
| | - B L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W F Draijer
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P B J Tilman
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N P Kort
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Abstract
Background and purpose - Implant inducible micromotions have been suggested to reflect the quality of the fixation interface. We investigated the usability of dynamic RSA for evaluation of inducible micromotions of the Oxford Unicompartmental Knee Arthroplasty (UKA) tibial component, and evaluated factors that have been suggested to compromise the fixation, such as fixation method, component alignment, and radiolucent lines (RLLs). Patients and methods - 15 patients (12 men) with a mean age of 69 (55-86) years, with an Oxford UKA (7 cemented), were studied after a mean time in situ of 4.4 (3.6-5.1) years. 4 had tibial RLLs. Each patient was recorded with dynamic RSA (10 frames/second) during a step-up/step-down motion. Inducible micromotions were calculated for the tibial component with respect to the tibia bone. Postoperative component alignment was measured with model-based RSA and RLLs were measured on screened radiographs. Results - All tibial components showed inducible micromotions as a function of the step-cycle motion with a mean subsidence of up to -0.06 mm (95% CI: -0.10 to -0.03). Tibial component inducible micromotions were similar for cemented fixation and cementless fixation. Patients with tibial RLLs had 0.5° (95% CI: 0.18-0.81) greater inducible medio-lateral tilt of the tibial component. There was a correlation between postoperative posterior slope of the tibial plateau and inducible anterior-posterior tilt. Interpretation - All patients had inducible micromotions of the tibial component during step-cycle motion. RLLs and a high posterior slope increased the magnitude of inducible micromotions. This suggests that dynamic RSA is a valuable clinical tool for the evaluation of functional implant fixation.
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Affiliation(s)
- Kristian Horsager
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark;,Correspondence:
| | - Bart L Kaptein
- Department of Orthopedic Surgery, Biomechanics and Imaging Group, Leiden University Medical Center, Leiden, the Netherlands
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter B Jørgensen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Stentz-Olesen K, Nielsen ET, De Raedt S, Jørgensen PB, Sørensen OG, Kaptein BL, Andersen MS, Stilling M. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017; 6:376-384. [PMID: 28600383 PMCID: PMC5492337 DOI: 10.1302/2046-3758.66.bjr-2016-0113.r3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/13/2017] [Indexed: 11/05/2022] Open
Abstract
Objectives Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. Methods Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs. Results Results showed a mean difference between the two methods in all six degrees of freedom for static RSA to be within -0.10 mm/° and 0.08 mm/° with a 95% limit of agreement (LoA) ranging from ± 0.49 to 1.26. Dynamic RSA had a slightly larger range in mean difference of -0.23 mm/° to 0.16 mm/° with LoA ranging from ± 0.75 to 1.50. Conclusions In a laboratory-controlled setting, the CT model method combined with dynamic RSA may be an alternative to previous marker-based methods for kinematic analyses. Cite this article: K. Stentz-Olesen, E. T. Nielsen, S. De Raedt, P. B. Jørgensen, O. G. Sørensen, B. L. Kaptein, M. S. Andersen, M. Stilling. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017;6:376–384. DOI: 10.1302/2046-3758.66.BJR-2016-0113.R3.
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Affiliation(s)
- K Stentz-Olesen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - E T Nielsen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - S De Raedt
- Nordisk Røntgen Teknik, Birkegårdsvej 16, 8361 Hesselager, Denmark
| | - P B Jørgensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 9A, 8000 Aarhus C, Denmark
| | - O G Sørensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherland
| | - M S Andersen
- Department of Mechanical Engineering and Manufacturing, Aalborg University, Fibigerstræde 16, 9220 Aalborg East, Denmark
| | - M Stilling
- Orthopaedic Research Group, Departments of Orthopaedic Surgery and Clinical Medicine, Aarhus University Hospital, University of Aarhus, Tage-Hansens Gade 2, Building 10A, 8000 Aarhus C, Denmark
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van der Voort P, Valstar ER, Kaptein BL, Fiocco M, van der Heide HJL, Nelissen RGHH. Comparison of femoral component migration between Refobacin bone cement R and Palacos R + G in cemented total hip arthroplasty: A randomised controlled roentgen stereophotogrammetric analysis and clinical study. Bone Joint J 2016; 98-B:1333-1341. [PMID: 27694586 DOI: 10.1302/0301-620x.98b10.37116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The widely used and well-proven Palacos R (a.k.a. Refobacin Palacos R) bone cement is no longer commercially available and was superseded by Refobacin bone cement R and Palacos R + G in 2005. However, the performance of these newly introduced bone cements have not been tested in a phased evidence-based manner, including roentgen stereophotogrammetric analysis (RSA). PATIENTS AND METHODS In this blinded, randomised, clinical RSA study, the migration of the Stanmore femoral component was compared between Refobacin bone cement R and Palacos R + G in 62 consecutive total hip arthroplasties. The primary outcome measure was femoral component migration measured using RSA and secondary outcomes were Harris hip score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol 5D (EQ-5D) and Short Form 36 (SF-36). RESULTS Femoral component migration was comparable between Refobacin bone cement R and Palacos R + G during the two-year follow-up period with an estimated mean difference of 0.06 mm of subsidence (p = 0.56) and 0.08° of retroversion (p = 0.82). Five hips (three Refobacin bone cement R and two Palacos R + G) showed non-stabilising, continuous migration; the femoral cement mantle in these hips, was mean 0.7 mm thicker (p = 0.02) and there were more radiolucencies at the bone-cement interface (p = 0.004) in comparison to hips showing stabilising migration. Post-operative HHS was comparable throughout the follow-up period (p = 0.62). HOOS, EQ5D, and SF-36 scores were also comparable (p-values > 0.05) at the two-year follow-up point. CONCLUSION Refobacin bone cement R and Palacos R + G show comparable component migration and clinical outcome during the first two post-operative years. Hips showing continuous migration are at risk for early failure. However, this seems to be unrelated to cement type, but rather to cementing technique. Cite this article: Bone Joint J 2016;98-B:1333-41.
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Affiliation(s)
- P van der Voort
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - E R Valstar
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - M Fiocco
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - H J L van der Heide
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
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Meinardi JE, Valstar ER, Van Der Voort P, Kaptein BL, Fiocco M, Nelissen RGHH. Palacos compared to Palamed bone cement in total hip replacement: a randomized controlled trial. Acta Orthop 2016; 87:473-8. [PMID: 27329869 PMCID: PMC5016905 DOI: 10.1080/17453674.2016.1199146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Stability and survival of cemented total hip prostheses is dependent on a multitude of factors, including the type of cement that is used. Bone cements vary in viscosity, from low to medium and high. There have been few clinical RSA studies comparing the performance of low- and high-viscosity bone cements. We compared the migration behavior of the Stanmore hip stem cemented using novel low-viscosity Palamed bone cement with that of the same stem cemented with conventional high-viscosity Palacos bone cement. Patients and methods - We performed a randomized controlled study involving 39 patients (40 hips) undergoing primary total hip replacement for primary or secondary osteoarthritis. 22 patients (22 hips) were randomized to Palacos and 17 patients (18 hips) were randomized to Palamed. Migration was determined by RSA. Results - None of these 40 hips had been revised at the 10-year follow-up mark. To our knowledge, the patients who died before they reached the 10-year endpoint still had the implant in situ. No statistically significant or clinically significant differences were found between the 2 groups for mean translations, rotations, and maximum total-point motion (MTPM). Interpretation - We found similar migration of the Stanmore stem in the high-viscosity Palacos cement group and the low-viscosity Palamed cement group. We therefore expect that the risk of aseptic loosening with the new Palamed cement would be comparable to that with the conventional Palacos cement. The choice of which type of bone cement to use is therefore up to the surgeon's preference.
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Affiliation(s)
- Joris E Meinardi
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Correspondence:
| | - Edward R Valstar
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft
| | - Paul Van Der Voort
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden;,Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
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van IJsseldijk EA, Valstar ER, Stoel BC, Nelissen RGHH, Baka N, Van't Klooster R, Kaptein BL. Three dimensional measurement of minimum joint space width in the knee from stereo radiographs using statistical shape models. Bone Joint Res 2016; 5:320-7. [PMID: 27491660 PMCID: PMC5005472 DOI: 10.1302/2046-3758.58.2000626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/05/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives An important measure for the diagnosis and monitoring of knee osteoarthritis is the minimum joint space width (mJSW). This requires accurate alignment of the x-ray beam with the tibial plateau, which may not be accomplished in practice. We investigate the feasibility of a new mJSW measurement method from stereo radiographs using 3D statistical shape models (SSM) and evaluate its sensitivity to changes in the mJSW and its robustness to variations in patient positioning and bone geometry. Materials and Methods A validation study was performed using five cadaver specimens. The actual mJSW was varied and images were acquired with variation in the cadaver positioning. For comparison purposes, the mJSW was also assessed from plain radiographs. To study the influence of SSM model accuracy, the 3D mJSW measurement was repeated with models from the actual bones, obtained from CT scans. Results The SSM-based measurement method was more robust (consistent output for a wide range of input data/consistent output under varying measurement circumstances) than the conventional 2D method, showing that the 3D reconstruction indeed reduces the influence of patient positioning. However, the SSM-based method showed comparable sensitivity to changes in the mJSW with respect to the conventional method. The CT-based measurement was more accurate than the SSM-based measurement (smallest detectable differences 0.55 mm versus 0. 82 mm, respectively). Conclusion The proposed measurement method is not a substitute for the conventional 2D measurement due to limitations in the SSM model accuracy. However, further improvement of the model accuracy and optimisation technique can be obtained. Combined with the promising options for applications using quantitative information on bone morphology, SSM based 3D reconstructions of natural knees are attractive for further development. Cite this article: E. A. van IJsseldijk, E. R. Valstar, B. C. Stoel, R. G. H. H. Nelissen, N. Baka, R. van’t Klooster, B. L. Kaptein. Three dimensional measurement of minimum joint space width in the knee from stereo radiographs using statistical shape models. Bone Joint Res 2016;320–327. DOI: 10.1302/2046-3758.58.2000626.
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Affiliation(s)
- E A van IJsseldijk
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - E R Valstar
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B C Stoel
- Department of Radiology, Leiden University Medical Center, Division of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - N Baka
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R Van't Klooster
- Department of Radiology, Leiden University Medical Center, Division of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
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Seehaus F, Schwarze M, Flörkemeier T, von Lewinski G, Kaptein BL, Jakubowitz E, Hurschler C. Use of single-representative reverse-engineered surface-models for RSA does not affect measurement accuracy and precision. J Orthop Res 2016; 34:903-10. [PMID: 26553748 DOI: 10.1002/jor.23098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/03/2015] [Indexed: 02/04/2023]
Abstract
Implant migration can be accurately quantified by model-based Roentgen stereophotogrammetric analysis (RSA), using an implant surface model to locate the implant relative to the bone. In a clinical situation, a single reverse engineering (RE) model for each implant type and size is used. It is unclear to what extent the accuracy and precision of migration measurement is affected by implant manufacturing variability unaccounted for by a single representative model. Individual RE models were generated for five short-stem hip implants of the same type and size. Two phantom analyses and one clinical analysis were performed: "Accuracy-matched models": one stem was assessed, and the results from the original RE model were compared with randomly selected models. "Accuracy-random model": each of the five stems was assessed and analyzed using one randomly selected RE model. "Precision-clinical setting": implant migration was calculated for eight patients, and all five available RE models were applied to each case. For the two phantom experiments, the 95%CI of the bias ranged from -0.28 mm to 0.30 mm for translation and -2.3° to 2.5° for rotation. In the clinical setting, precision is less than 0.5 mm and 1.2° for translation and rotation, respectively, except for rotations about the proximodistal axis (<4.1°). High accuracy and precision of model-based RSA can be achieved and are not biased by using a single representative RE model. At least for implants similar in shape to the investigated short-stem, individual models are not necessary. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:903-910, 2016.
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Affiliation(s)
- Frank Seehaus
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
| | - Thilo Flörkemeier
- Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
| | - Gabriela von Lewinski
- Department of Orthopaedics, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
| | - Bart L Kaptein
- Department of Orthopaedics, Division of Division of Image Processing, Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany
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Prins AH, Kaptein BL, Stoel BC, Lahaye DJP, Valstar ER. Performance of local optimization in single-plane fluoroscopic analysis for total knee arthroplasty. J Biomech 2015; 48:3837-45. [PMID: 26435183 DOI: 10.1016/j.jbiomech.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/21/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Fluoroscopy-derived joint kinematics plays an important role in the evaluation of knee prostheses. Fluoroscopic analysis requires estimation of the 3D prosthesis pose from its 2D silhouette in the fluoroscopic image, by optimizing a dissimilarity measure. Currently, extensive user-interaction is needed, which makes analysis labor-intensive and operator-dependent. The aim of this study was to review five optimization methods for 3D pose estimation and to assess their performance in finding the correct solution. Two derivative-free optimizers (DHSAnn and IIPM) and three gradient-based optimizers (LevMar, DoNLP2 and IpOpt) were evaluated. For the latter three optimizers two different implementations were evaluated: one with a numerically approximated gradient and one with an analytically derived gradient for computational efficiency. On phantom data, all methods were able to find the 3D pose within 1mm and 1° in more than 85% of cases. IpOpt had the highest success-rate: 97%. On clinical data, the success rates were higher than 85% for the in-plane positions, but not for the rotations. IpOpt was the most expensive method and the application of an analytically derived gradients accelerated the gradient-based methods by a factor 3-4 without any differences in success rate. In conclusion, 85% of the frames can be analyzed automatically in clinical data and only 15% of the frames require manual supervision. The optimal success-rate on phantom data (97% with IpOpt) on phantom data indicates that even less supervision may become feasible.
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Affiliation(s)
- A H Prins
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, The Netherlands
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, The Netherlands.
| | - B C Stoel
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, The Netherlands
| | - D J P Lahaye
- Department of Applied Mathematics, Faculty Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, The Netherlands
| | - E R Valstar
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, The Netherlands
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Campoli G, Baka N, Kaptein BL, Valstar ER, Zachow S, Weinans H, Zadpoor AA. Relationship between the shape and density distribution of the femur and its natural frequencies of vibration. J Biomech 2014; 47:3334-43. [PMID: 25171786 DOI: 10.1016/j.jbiomech.2014.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 11/17/2022]
Abstract
It has been recently suggested that mechanical loads applied at frequencies close to the natural frequencies of bone could enhance bone apposition due to the resonance phenomenon. Other applications of bone modal analysis are also suggested. For the above-mentioned applications, it is important to understand how patient-specific bone shape and density distribution influence the natural frequencies of bones. We used finite element models to study the effects of bone shape and density distribution on the natural frequencies of the femur in free boundary conditions. A statistical shape and appearance model that describes shape and density distribution independently was created, based on a training set of 27 femora. The natural frequencies were then calculated for different shape modes varied around the mean shape while keeping the mean density distribution, for different appearance modes around the mean density distribution while keeping the mean bone shape, and for the 27 training femora. Single shape or appearance modes could cause up to 15% variations in the natural frequencies with certain modes having the greatest impact. For the actual femora, shape and density distribution changed the natural frequencies by up to 38%. First appearance mode that describes the general cortical bone thickness and trabecular bone density had one of the strongest impacts. The first appearance mode could therefore provide a sensitive measure of general bone health and disease progression. Since shape and density could cause large variations in the calculated natural frequencies, patient-specific FE models are needed for accurate estimation of bone natural frequencies.
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Affiliation(s)
- G Campoli
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
| | - N Baka
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E R Valstar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands; Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - S Zachow
- Visualization & Data Analysis Medical Planning & Computational Medicine Groups, Zuse Institute Berlin (ZIB), Berlin, Germany
| | - H Weinans
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands; Departments of Orthopedics and Rheumatology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands.
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van IJsseldijk EA, Harman MK, Luetzner J, Valstar ER, Stoel BC, Nelissen RGHH, Kaptein BL. Validation of a model-based measurement of the minimum insert thickness of knee prostheses: a retrieval study. Bone Joint Res 2014; 3:289-96. [PMID: 25278502 PMCID: PMC4220171 DOI: 10.1302/2046-3758.310.2000304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Wear of polyethylene inserts plays an important role in failure of total knee replacement and can be monitored in vivo by measuring the minimum joint space width in anteroposterior radiographs. The objective of this retrospective cross-sectional study was to compare the accuracy and precision of a new model-based method with the conventional method by analysing the difference between the minimum joint space width measurements and the actual thickness of retrieved polyethylene tibial inserts. METHOD Before revision, the minimum joint space width values and their locations on the insert were measured in 15 fully weight-bearing radiographs. These measurements were compared with the actual minimum thickness values and locations of the retrieved tibial inserts after revision. RESULTS The mean error in the model-based minimum joint space width measurement was significantly smaller than the conventional method for medial condyles (0.50 vs 0.94 mm, p < 0.01) and for lateral condyles (0.06 vs 0.34 mm, p = 0.02). The precision (standard deviation of the error) of the methods was similar (0.84 vs 0.79 mm medially and both 0.46 mm laterally). The distance between the true minimum joint space width locations and the locations from the model-based measurements was less than 10 mm in the medial direction in 12 cases and less in the lateral direction in 13 cases. CONCLUSION The model-based minimum joint space width measurement method is more accurate than the conventional measurement with the same precision. Cite this article: Bone Joint Res 2014;3:289-96.
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Affiliation(s)
- E A van IJsseldijk
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - M K Harman
- Clemson University, Department of Bioengineering, 301 Rhodes Engineering Research Center, Clemson, 29634, USA
| | - J Luetzner
- University Hospital Carl Gustav Carus, Department of Orthopaedic and Trauma Surgery, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - E R Valstar
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B C Stoel
- Leiden University Medical Center, Department of Radiology, Div. of Image Processing, PO 9600, 2300 RC, Leiden, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Department of Orthopaedics, Biomechanics and Imaging Group, PO 9600, 2300 RC, Leiden, The Netherlands
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van Ijsseldijk EA, Valstar ER, Stoel BC, de Ridder R, Nelissen RGHH, Kaptein BL. Measuring polyethylene wear in total knee arthroplasty by RSA: differences between weight-bearing and non-weight-bearing positioning. J Orthop Res 2014; 32:613-7. [PMID: 24395396 DOI: 10.1002/jor.22579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/06/2013] [Indexed: 02/04/2023]
Abstract
Measuring the minimum-joint-space-width (mJSW) in total knee arthroplasty (TKA) in Roentgen stereophotogrammetric analysis (RSA) provides valuable information on polyethylene wear, a leading cause for TKA failure. Most existing studies use non-weight-bearing (NWB) patient positioning. The latter may compromise mJSW measurements due to knee laxity with subsequent non-contact between the TKA components. We investigated the difference in mJSW between weight-bearing (WB) and NWB images and the association with mediolateral (ML) knee stability. At one-year follow-up, 23 TKAs were included from an ongoing RSA study, and ML stability was evaluated. For each examination, the mJSW and femoral-tibial contact locations were measured. A linear regression model was used to analyze the association between the mJSW difference (NWB-WB) with the ML stability and contact locations. The mean mJSW difference was 0.28 mm medially and 0.20 mm laterally. Four TKAs had medium (5-9°) and 19 TKAs had high (<5°) ML stability. A higher mJSW difference was found for TKAs with medium stability (0.36 mm, P = 0.01). In conclusion, mJSW measurements in existing (NWB) RSA studies are influenced by knee laxity, but may still provide information on wear progression based on TKA with high ML stability. A direct comparison of mJSW measurements from WB and NWB data is not possible.
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Affiliation(s)
- Emiel A van Ijsseldijk
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Baka N, Kaptein BL, Giphart JE, Staring M, de Bruijne M, Lelieveldt BPF, Valstar E. Evaluation of automated statistical shape model based knee kinematics from biplane fluoroscopy. J Biomech 2013; 47:122-9. [PMID: 24207131 DOI: 10.1016/j.jbiomech.2013.09.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/18/2022]
Abstract
State-of-the-art fluoroscopic knee kinematic analysis methods require the patient-specific bone shapes segmented from CT or MRI. Substituting the patient-specific bone shapes with personalizable models, such as statistical shape models (SSM), could eliminate the CT/MRI acquisitions, and thereby decrease costs and radiation dose (when eliminating CT). SSM based kinematics, however, have not yet been evaluated on clinically relevant joint motion parameters. Therefore, in this work the applicability of SSMs for computing knee kinematics from biplane fluoroscopic sequences was explored. Kinematic precision with an edge based automated bone tracking method using SSMs was evaluated on 6 cadaveric and 10 in-vivo fluoroscopic sequences. The SSMs of the femur and the tibia-fibula were created using 61 training datasets. Kinematic precision was determined for medial-lateral tibial shift, anterior-posterior tibial drawer, joint distraction-contraction, flexion, tibial rotation and adduction. The relationship between kinematic precision and bone shape accuracy was also investigated. The SSM based kinematics resulted in sub-millimeter (0.48-0.81mm) and approximately 1° (0.69-0.99°) median precision on the cadaveric knees compared to bone-marker-based kinematics. The precision on the in-vivo datasets was comparable to that of the cadaveric sequences when evaluated with a semi-automatic reference method. These results are promising, though further work is necessary to reach the accuracy of CT-based kinematics. We also demonstrated that a better shape reconstruction accuracy does not automatically imply a better kinematic precision. This result suggests that the ability of accurately fitting the edges in the fluoroscopic sequences has a larger role in determining the kinematic precision than that of the overall 3D shape accuracy.
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Affiliation(s)
- Nora Baka
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - J Erik Giphart
- Department of Bio-Medical Engineering, Steadman Philippon Research Institute, Vail, USA
| | - Marius Staring
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen de Bruijne
- Departments of Medical Informatics and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Computer Science, University of Copenhagen, Denmark
| | | | - Edward Valstar
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, The Netherlands
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Nieuwenhuijse MJ, van der Voort P, Kaptein BL, van der Linden-van der Zwaag HMJ, Valstar ER, Nelissen RGHH. Fixation of high-flexion total knee prostheses: five-year follow-up results of a four-arm randomized controlled clinical and roentgen stereophotogrammetric analysis study. J Bone Joint Surg Am 2013; 95:e1411-11. [PMID: 24088976 DOI: 10.2106/jbjs.l.01523] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High-flexion total knee arthroplasty was introduced to meet the demands of daily activity requiring increased knee flexion. However, concerns have been raised regarding the fixation of high-flexion total knee arthroplasty components and increased rates of loosening have been reported. To date, migration, and thus fixation, of high-flexion total knee arthroplasty components has not been analyzed and the preferential bearing type (mobile or fixed) is unknown. METHODS Of eighty-six consecutive eligible patients, seventy-four patients (seventy-eight knees) scheduled for total knee arthroplasty were randomized to one of four Legacy Posterior Stabilized (LPS) total knee prosthesis designs: (1) LPS-Flex mobile, (2) LPS-Flex fixed, (3) LPS mobile, and (4) LPS fixed. The primary outcome was component migration measured with use of Roentgen stereophotogrammetric analysis, and secondary outcomes were postoperative knee flexion and extension and Knee Society Score. Patients were evaluated postoperatively at six, twelve, twenty-six, and fifty-two weeks and annually thereafter. At the five-year follow-up, eight patients had died and two patients were lost to follow-up. Seventy-seven tibial and forty-two femoral components were suitable for migration measurements. RESULTS The overall five-year migration of the seventy-seven tibial components was not significantly different among the four total knee prosthesis designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.02 to 0.25 mm) and migration was comparable at the two and five-year follow-up. Migration stabilized in all but three components (two LPS-Flex mobile and one LPS fixed); one of these components has already been revised and was aseptically loose. The overall five-year migration of the forty-two femoral components was comparable among the four designs (compared with the LPS fixed design, the range of overall mean differences for the other three designs was 0.01 to 0.18 mm) and was similar at two and five years postoperatively. One femoral component (LPS-Flex mobile) migrated excessively. In patients who had a mean postoperative flexion of ≥ 125° or a maximum flexion of ≥ 135° during the one to five-year follow-up period, migration of high-flexion components was comparable with that of conventional components and indicative of appropriate fixation. Postoperative flexion, extension, Knee Society Score, and Knee Society Score function were comparable during the five-year follow-up period and at the two and five-year follow-up. CONCLUSIONS The LPS-Flex total knee prosthesis with either a mobile or a fixed bearing had migration comparable that of with its conventional counterpart and is expected to have similar (excellent) long-term survival in these patients. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail address for M.J. Nieuwenhuijse:
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Seehaus F, Emmerich J, Kaptein BL, Windhagen H, Hurschler C. Dependence of model-based RSA accuracy on higher and lower implant surface model quality. Biomed Eng Online 2013; 12:32. [PMID: 23587251 PMCID: PMC3637620 DOI: 10.1186/1475-925x-12-32] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background Model-based Roentgen Stereophotogrammetric Analysis (MBRSA) allows the accurate in vivo measurement of the relative motion between an implant and the surrounding bone (migration), using pose-estimation algorithms and three dimensional geometric surface models of the implant. The goal of this study was thus to investigate the effect of surface model resolution on the accuracy of the MBRSA method. Methods Four different implant geometries (knee femoral and tibial components, and two different hip stems) were investigated, for each of which two reversed engineering (RE) models of differing spatial digitizing resolution were generated. Accuracy of implant migration measurement using MBRSA was assessed in dependence on surface model resolution using an experimental phantom-model set up. Results When using the lower quality RE models, the worst bias observed ranged from -0.048 to 0.037 mm, and -0.057 to 0.078 deg for translation and rotation respectively. For higher quality reverse engineering models, bias ranged from -0.042 to 0.048 mm, and -0.449 to 0.029 deg. The pair-wise comparisons of digitizing resolution (higher vs. lower quality) within the different implant type revealed significant differences only for the hip stems (p < 0.001). Conclusion The data suggest that the application of lower resolution RE models for MBRSA is a viable alternative method for the in vivo measurement of implant migration, in particular for implants with non symmetrical geometries (total knee arthroplasty). Implants with larger length to width aspect ratio (total hip arthroplasty) may require high resolution RE models in order to achieve acceptable accuracy. Conversely, for some axis the bias for translation are clearly worse for translation, and are marginally better for rotations using the lower resolution RE models instead of the higher ones. However, performed box plots ranges were well within what has been reported in the literature. The observed lower accuracy and precision of the measurements for hip stem components for rotations about the superior-inferior direction is presumably the result of the nature of the MBRSA method. This well known effect within MBRSA for rotations about the axis of symmetry of axially-symmetric objects do not change the contour of the projected image to as large a degree as motion about a non-symmetric axes. It is not possible to detected this small motion as accurately using pose-estimation methods. This may affect the “higher” accuracy for the applied lower resolution RE models.
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Baka N, de Bruijne M, van Walsum T, Kaptein BL, Giphart JE, Schaap M, Niessen WJ, Lelieveldt BPF. Statistical shape model-based femur kinematics from biplane fluoroscopy. IEEE Trans Med Imaging 2012; 31:1573-1583. [PMID: 22547454 DOI: 10.1109/tmi.2012.2195783] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Studying joint kinematics is of interest to improve prosthesis design and to characterize postoperative motion. State of the art techniques register bones segmented from prior computed tomography or magnetic resonance scans with X-ray fluoroscopic sequences. Elimination of the prior 3D acquisition could potentially lower costs and radiation dose. Therefore, we propose to substitute the segmented bone surface with a statistical shape model based estimate. A dedicated dynamic reconstruction and tracking algorithm was developed estimating the shape based on all frames, and pose per frame. The algorithm minimizes the difference between the projected bone contour and image edges. To increase robustness, we employ a dynamic prior, image features, and prior knowledge about bone edge appearances. This enables tracking and reconstruction from a single initial pose per sequence. We evaluated our method on the distal femur using eight biplane fluoroscopic drop-landing sequences. The proposed dynamic prior and features increased the convergence rate of the reconstruction from 71% to 91%, using a convergence limit of 3 mm. The achieved root mean square point-to-surface accuracy at the converged frames was 1.48 ± 0.41 mm. The resulting tracking precision was 1-1.5 mm, with the largest errors occurring in the rotation around the femoral shaft (about 2.5° precision).
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Affiliation(s)
- N Baka
- Department of Medical Informatics, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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47
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Seehaus F, Sukau A, Budde S, Kaptein BL, Windhagen H, Hurschler C. MAY ALIGNED LOCAL COORDINATE SYSTEMS INCREASE MODEL-BASED RSA ACCURACY? J Biomech 2012. [DOI: 10.1016/s0021-9290(12)70364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bosman WMPF, Hinnen JW, Kopp WH, van der Steenhoven TJ, Kaptein BL, Koning OHJ, Hamming JF. Influence of aneurysm wall stiffness and the presence of intraluminal thrombus on the wall movement of an aneurysm - an in vitro study. Vascular 2012; 20:203-9. [PMID: 22661613 DOI: 10.1258/vasc.2011.oa0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this in vitro study was to investigate the influence of aneurysm wall stiffness and of the presence of intraluminal thrombus (ILT) on aneurysm wall movement. Three latex aneurysms were used with different wall stiffness. The aneurysms, equipped with 20 tantalum markers, were attached to an in vitro circulation model. Fluoroscopic roentgenographic stereo photogrammetric analysis was used to measure marker movement during six cardiac cycles at three different systemic pressures. To investigate the influence of ILT on wall movement, we repeated the same experiment with one of the aneurysms. The aneurysm sac was then filled with one of two E-moduli differing thrombus analogues (Novalyse 8 and 20) or with perfusate as a control. It was noted that the amplitude of the wall movement (mm) increased significantly (P < 0.05) as the compliance of the wall increased. The mean amplitude of the wall movement decreased (P < 0.05) as the stiffness (E-modulus) of the ILT increased. In conclusion, ILT has a 'cushioning effect'. Wall movement (and theoretically wall stress) diminishes when the stiffness of the ILT increases. Compliance of the aneurysm wall influences wall movement. When the stiffness of the wall increases, the wall movement diminishes.
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Affiliation(s)
- W M P F Bosman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Nieuwenhuijse MJ, Valstar ER, Kaptein BL, Nelissen RGHH. Good diagnostic performance of early migration as a predictor of late aseptic loosening of acetabular cups: results from ten years of follow-up with Roentgen stereophotogrammetric analysis (RSA). J Bone Joint Surg Am 2012; 94:874-80. [PMID: 22617914 DOI: 10.2106/jbjs.k.00305] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Excessive early migration of femoral stems following total hip arthroplasty and tibial components following total knee arthroplasty is associated with their long-term survival and allows reliable early evaluation of implant performance. However, a similar relationship involving acetabular components following hip arthroplasty has not been evaluated. This prospective, long-term study with clinical and Roentgen stereophotogrammetric analysis (RSA) follow-up establishes the existence of this relationship and its associated diagnostic performance. METHODS Thirty-nine consecutive patients (forty-one hips) who underwent total hip arthroplasty with a cemented Exeter stem and a cemented Exeter all-polyethylene cup had prospective clinical and RSA follow-up. Patients were evaluated postoperatively at six weeks, at three, six, and twelve months, and annually thereafter. Conventional anteroposterior and lateral radiographs were made at six weeks and at two, five, and ten years postoperatively as well as when indicated. The mean duration of follow-up (and standard deviation) was 9.4 ± 3.2 years. No patients were lost to follow-up; fifteen patients died during the follow-up period. RESULTS Eleven acetabular components were observed to be loose on conventional radiographs after a mean of seventy-six months (range, twelve to 140 months). During the first two postoperative years, the failed acetabular components showed markedly greater and more rapid cranial translation and sagittal rotation. Both cranial translation (hazard ratio = 19.9 [95% confidence interval, 4.94 to 80.0], p < 0.001) and sagittal rotation (hazard ratio = 11.1 [95% confidence interval, 2.83 to 43.9], p = 0.001) were strong risk factors for late aseptic loosening. Eight of the eleven failed components showed a distinctive pattern of excessive cranial translation combined with excessive sagittal rotation. The associated diagnostic performance of two-year cranial translation and/or sagittal rotation for predicting late aseptic loosening of the acetabular component was good (area under the receiver operating characteristic curve, 0.88 [95% confidence interval, 0.74 to 1.00; p < 0.001] and 0.84 [95% confidence interval, 0.68 to 1.00; p = 0.001], respectively). CONCLUSIONS Early migration, as measured by RSA at two years postoperatively, has good diagnostic capabilities for the detection of acetabular components at risk for future aseptic loosening, and this method appears to be an appropriate means of assessing the performance of new implants or implant-related changes.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Nieuwenhuijse MJ, Valstar ER, Kaptein BL, Nelissen RGHH. The Exeter femoral stem continues to migrate during its first decade after implantation: 10-12 years of follow-up with radiostereometric analysis (RSA). Acta Orthop 2012; 83:129-34. [PMID: 22401676 PMCID: PMC3339525 DOI: 10.3109/17453674.2012.672093] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Due to its collarless, double-tapered polished design, the Exeter femoral stem is known to migrate distally in the first 5 years after implantation. However, its long-term migration pattern has not been investigated. PATIENTS AND METHODS 39 consecutive patients (41 total hip arthroplasties) received a cemented Exeter stem and had prospective clinical and RSA follow-up. Patients were evaluated postoperatively at 6, 12, 26, and 52 weeks, and annually thereafter. Short-term results have been reported. In this study, the mean length of follow-up was 9.4 years (SD 3.2 years). No patients were lost to follow-up. 15 patients died during follow-up. RESULTS No stems were revised. In 4 stems, fractures of the cement mantle were noted within the first 3 postoperative years. In 3 stems, this resulted in a complete circumferential cement mantle discontinuity. For the 37 well-performing stems, continuous but small migration was measured between 2 and 12 years of follow-up. Continued subsidence of 0.08 mm/year (95% CI: 0.05-0.12, p < 0.001) was seen in combination with continued rotation in retroversion of 0.07°/year (95% CI: 0.02-0.12, p = 0.01). At 10 years of follow-up, mean subsidence was 2.1 (SD 1.2) mm and mean retroversion was 1.8° (SD 2.0). Two-thirds of this occurred during the first 2 postoperative years. In the 3 stems with a complete circumferential cement fracture, a sudden and disproportionately high increase in subsidence was measured in the time period of occurrence. INTERPRETATION The Exeter femoral stem continues to migrate during the first decade after implantation. Absolute stability is not required for good long-term survival if this is compatible with the design of the implant.
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Affiliation(s)
- Marc J Nieuwenhuijse
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden
| | | | - Bart L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden
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